Reductions in Readmission Rates Are Associated With Modest Improvements in Patient-reported Health Gains Following Hip and Knee Replacement in England
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Key result
Each percentage point reduction in the risk-adjusted readmission rate for hip replacement was associated with an additional health gain of 0.004 for EQ-5D, indicating no unintended harm to patient outcomes.
Why the study?
Are reductions in hospital readmission rates associated with improvements in patient-reported health gains following hip and knee replacement?
Population
273,108 patients at NHS Trusts in England between April 2010 and February 2013.
Design
Cohort
Follow-up
6 months
Authors
Discussion
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Member takes
Implication
Reassures that hospital readmission reduction efforts do not compromise patient-reported quality of life.
Study Design
Type
Observational (n=273,108)
Multicenter
Yes
Structured PICO
Are reductions in hospital readmission rates associated with improvements in patient-reported health gains following hip and knee replacement?
P
Population
273,108 adults aged 18 and older undergoing planned hip or knee replacement surgery at NHS Trusts in England, with patient-reported outcomes assessed at 6 months.
E
Exposure
Hospital-level reductions in risk-adjusted 30-day readmission rates
O
Outcome
Changes in patient-reported health between presurgical assessment and 6-month follow-up, using general health EuroQuol five dimensions questionaire (EQ-5D), EuroQuol visual analogue scales (EQ-VAS), and procedure-specific (Oxford Hip and Knee Scores) measurespatient reported
Main Result
Mean Difference: 0.004 (95% CI 0.002–0.006)
p-value: p=<0.01
Reductions in hospital readmission rates following hip and knee replacement are associated with modest improvements in patient-reported health outcomes, suggesting that efforts to reduce readmissions do not negatively impact patient well-being.
Limitations
- Missing PROMs data for non-respondents, who may differ systematically from respondents
- Susceptible to changes in case-mix over time and between Trusts not fully captured by risk-adjustment
- Time-varying confounders such as the establishment of specialist hip and knee centers
- Observational design cannot entirely discount other factors explaining the associations
- Measurement of health gain was restricted to those who returned the PROMs questionnaires
- Susceptible to changes in case-mix over time and between Trusts
- Susceptible to time-varying confounders, such as the establishment of specialist hip and knee centers
Cite This Study
Friebel et al. (2017) conducted an observational in Hip and knee replacement (n=273,108). Reduction in risk-adjusted 30-day readmission rate vs. Hospitals with lesser or no reduction in readmission rates was evaluated on Change in risk-adjusted health gain (EQ-5D) following hip replacement per 1 percentage point reduction in readmission rate (MD 0.004, 95% CI 0.002-0.006, p=<0.01). Each percentage point reduction in the risk-adjusted readmission rate for hip replacement was associated with an additional health gain of 0.004 for EQ-5D, indicating no unintended harm to patient outcomes.
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